Leprosy - known today as Hansen's disease - entered England in the 4th century AD and was endemic by 1050. During the medieval period, its disabling consequences were visible in communities across England - rural and urban, rich and poor. Between the close of the 11th century and about 1350, at least 350 religious houses and hospitals for the care of lepers - known as 'lazar' (leper) houses - were established in England. Few survive today, as many decayed or were destroyed during the dissolution of the monasteries in the 1530s. Yet a few extraordinary fragments remain. One example is the Old Leper Church of St Nicholas at Harbledown, Kent, built not long after the Norman Conquest as part of what is believed to have been England's first leper hospital. By the end of the 14th century, the church had been incorporated into almshouses that are still in use today.

Disease and disability in medieval England

As a rare and exceptionally early example of a purpose-built leper church, St Nicholas' offers historians insights into how leprosy affected its victims and into the complex attitudes of medieval society towards disability and disease. In its extreme form, leprosy causes loss of limbs, gangrene, blindness, lesions and weakening of the skeletal frame. Its debilitating impact on the body also produced complicated reactions from medieval communities: some believed it was a punishment for sin, but others saw the suffering of lepers as similar to the suffering of Christ. Because lepers were already enduring Purgatory on Earth, they would, it was suggested, go directly to Heaven when they died, and were therefore closer to God than other people. Those who cared for them or made charitable donations on their behalf believed that such good works would reduce their own time in Purgatory. Thus while fear of contagion was rife, leprosy sufferers like the patients of Harbledown were often treated with respect and allowed to keep in touch with family and friends.

Lanfranc's Foundation

St Nicholas' Hospital stands just outside Canterbury on the old main road to London, once England's chief pilgrimage route. As with others of its kind, it was purposely sited on a major highway, allowing inmates contact with society so they could beg for alms and offer prayers for the souls of benefactors. Like St Nicholas', most hospitals had their own chapels, and rituals based on prayer and singing went on throughout the day. The hospital was founded in about 1084 by Lanfranc, archbishop of Canterbury, and remained in operation as a lazar house until around 1400. Henry II visited it on his penitential journey to Canterbury in 1174 - following the murder of another archbishop of Canterbury, Thomas Becket - and he made an annual grant of 20 marks to the hospital. Built of local flint with stone dressings and a tiled roof, the church comprises a chancel and nave (both of Norman date and belonging to Lanfranc's original foundation), with a tower and north and south aisles added between the 12th and 14th centuries. A treasury at the end of the north aisle displays artefacts from the medieval hospital, and there is still some old glass dating from c. 1350 in the chancel windows. The church's floor slopes from east to west, which supposedly made it easier to wash it down after the lepers attended service.

Ground floor plan of the hospital

From hospital to almshouses

Attitudes towards lepers began to change in the 14th century, when new epidemics, especially the Black Death of 1347-50, led to further restrictions and isolation. However, by this time leprosy was in retreat, possibly due to greater immunity in the population, and many leper houses fell into disuse or, as here, became almshouses for the sick and disabled poor. In 1562, St Nicholas' was recorded as having had 60 places for poor men and women. The foundation was reconstituted three years later, and the domestic ranges were rebuilt in 1685 and again in 1840. It now offers sheltered accommodation to elderly residents. Explore the history of disability through England's protected environment.